Why This Moment Matters

We'll talk some other time about the political consequences, in 2010 and 2012 and beyond, of the health-care reform vote. (My guess: this will not seem anywhere near as poisonous seven months from now as it does today. Jobs jobs jobs is what will matter most then. But we'll see.)

We'll talk about the many things that will prove to be wrong with the bill, and the many more steps that will need to be taken as far into the future as anyone can see, so as to balance and rebalance the potentially-limitless cost of new medical procedures with the inevitably-limited resources that individuals, families, companies, and governments can spend.

For now, the significance of the vote is moving the United States FROM a system in which people can assume they will have health coverage IF they are old enough (Medicare), poor enough (Medicaid), fortunate enough (working for an employer that offers coverage, or able themselves to bear expenses), or in some other way specially positioned (veterans; elected officials)... TOWARD a system in which people can assume they will have health-care coverage. Period.

That is how the entire rest of the developed world operates, as noted yesterday. It is the way the United States operates in most realms other than health coverage. Of course all older people are eligible for Medicare. Of course all drivers must have auto insurance. Of course all children must have a public school they can attend. Etc. Such "of course" rules offer protection for individuals but even more important, they reduce the overall costs to society, compared with one in which extreme risks are uncontained. The simplest proof is, again, Medicare: Does anyone think American life would be better now, on an individual or a collective level, if we were in an environment in which older people might have to beg for treatment as charity cases when they ran out of cash? And in which everyone had to spend the preceding years worried about that fate?

There are countless areas in which America does it one way and everyone else does it another, and I say: I prefer the American way. Our practice on medical coverage is not one of these. Despite everything that is wrong with this bill and the thousand adjustments that will be necessary in the years to come, this is a very important step.

We want to hear what you think about this article. Submit a letter to the editor or write to letters@theatlantic.com.

James Fallows is a national correspondent for The Atlantic and has written for the magazine since the late 1970s. He has reported extensively from outside the United States and once worked as President Carter's chief speechwriter. He and his wife, Deborah Fallows, are the authors of the new book Our Towns: A 100,000-Mile Journey Into the Heart of America, which has been a New York Times best seller and is the basis of a forthcoming HBO documentary.